During intraoral operative procedures, and in particular during dental operative procedures, it is vital to maintain both a clear visual field of the operative site and to prevent iatrogenic damage to the surrounding hard and soft tissue. This is most often accomplished by retracting and/or physically preventing the cheek and tongue from contacting or blocking both the operative site and instrumentation such as dental rotary handpieces (drills), scalers, curettes, scalpels, forceps and the like. Isolation of the check, lip and tongue is also required for many non-operative dental procedures, such as the taking of dental impressions.
The art is replete with devices designed to isolate the cheek, lip and/or tongue. For example, U.S. Pat. No. 730,184 to Witter is directed to a retractor in the form of a U shaped frame having a buccal side, a lingual side and a detachable handle. The sides are connected anteriorly by a hinged connection which transverses the dental arch. The hinged connection permits the contraction or expansion of the frame to facilitate the engagement or disengagement of the teeth and to regulate the width of the opening to accommodate differing patients. A thumb wheel controls the expansion and contraction of the frame. A tooth clamp optionally holds the retractor in place.
U.S. Pat. No. 1,474,497 to Stolper is directed to a Z-shaped in cross section retractor. Extending from a shank at one end at a substantially right angle is a tongue and lip shield, and extending from the other end at a substantially right angle in the opposite direction is a cheek shield. The shank also serves as a handle. The shields transverse the dental arch anteriorly.
U.S. Pat. No. 2,125,980 to Basil is directed to a retractor having a tongue depressing element, a cheek retracting element, and a mirror. The tongue depressing element is connected with the free end of a rod which serves as a handle, the cheek retracting element is positioned adjacent to the handle, and the mirror is located between the cheek retracting element and the tongue depressing element. The handle is held such that it does not interfere with the dental arch.
U.S. Pat. No. 2,831,480 to Milano is directed to a retractor having a handle connected to a U shaped retraction element. The U shaped element contains a cheek retractor connected by a bridge containing recesses in width to allow for extension over the dental arch. While the upper and lower edges of the bridge contain a recess, there is sufficient extent between the recesses to insure the patient maintains adequate vertical opening. A tongue engaging element is joined at the outer end of the bridge.
U.S. Pat. No. 4,112,934 to Rizk is directed to a device for protecting the teeth and alveolar ridge during placement of a laryngoscope having a handle connected to a protective member. The protective member straddles the alveolar ridge and teeth preventing contact with the laryngoscope.
U.S. Pat. No. 5,873,718 to Sullivan is directed to a retractor having a hollow tube configured with a middle protrusion for tongue retraction and outer wings to retain the cheek and lip retractors.
U.S. Pat. No. 5,890,899 to Sclafani is directed to a retractor and jaw prop having a prop stem, a maxillary support secured to the prop stem, a buccal member depending angularly from the bottom of the prop stem, and a lingual member extending from the bottom of the prop stem and away from the buccal member. The buccal and lingual members are disposed on opposite sides of the dental arch, with the connecting member transversing the dental arch anteriorly.
U.S. Pat. No. 6,213,772 to Costello is directed to a retractor having a buccal shield and a lingual shield connected by an elastic hinge. Both buccal shield and lingual shield are hollow with orifices in communication with the oral cavity, essentially ovoid in shape, and contain a divider. Where the retractor exits the mouth, provision is made for attachment of high volume and low volume suction. The elastic hinge is used to provide a lateral expansion force to both the buccal shield and lingual shield to aid in retraction of the cheek and tongue.
These and other conventional retractor designs used to isolate the lip, cheek and tongue generally apply a force directed outwardly to either “push” or “pull” the soft tissue away from the operative field. Those designs which permit individual retraction of a lip or a cheek, but do not permit simultaneous retraction of both the lip and the cheek allow the to droop into the operative field when the cheek is retracted. Conversely, those designs allow the cheek to droop into the operative field when the lip is retracted.
Positive forces applied to retract soft tissues such as the cheek, lip and tongue can cause post operative patient muscle fatigue and/or pain, particularly if the forces are applied for extended time or applied excessively. Additionally, active retraction, particularly in patients with strong or heavy facial musculature, can cause clinician hand and arm fatigue, especially when repeated on multiple patients throughout the day.
Accordingly, there remains a need for a device that will maintain a clear operative field and prevent iatrogenic soft tissue damage without causing either patient or clinician muscle fatigue and pain. The present invention fulfills this need, and further provides related advantages.